Genealogy Search Application

This form may be printed and the information required may be completed by hand. 
 A signature is required before your application can be processed.
  
            Return the form using one of the following methods:

 

MAIL TO:
Buffalo County
Register of Deeds
PO Box 28
Alma, WI  54610-0028

FAX TO:
Buffalo County
 Register of Deeds
at
(608) 685-6213

IN PERSON AT:
Buffalo County
 Register of Deeds Office
407 South Second Street
Alma, WI  54610

 

1.  Name:  __________________________    2.  Drivers License Number: _______________________

3. Address:  ______________________________________________

4.  City:  ___________________    5. State: ______    6.  Zip: ______________

The Following Information Must Be Supplied By The Requestor:


7.  Purpose of search (specify reason, such as genealogy)
      ____________________________________________________________________________________
      ____________________________________________________________________________________
      ____________________________________________________________________________________

9. I will require and orientation (in office only): YES or NO

10.  I am familiar with the following vital records systems (Please circle all that apply):

        THIS OFFICE    OTHER COUNTIES    OTHER STATES    HISTORICAL SOCIETY

11. Records to be searched (Please circle all that apply):  BIRTH    DEATH    MARRIAGE

12.  Search includes these FULL NAMES and DATES:
      ____________________________________________________________________________________
      ____________________________________________________________________________________
      ____________________________________________________________________________________

 
I have read the Vital Statistics regulations and the office rules and agree to abide by them.  I understand that failure to comply with those regulations and rules will result in the application of the penalties prescribed.

 SIGNATURE: _______________________________________ DATE: _______________
PENALTIES according to Wisconsin Statutes 69.24: Up to $10,000 and 2 years imprisonment for illegal issuance or creation of copies of vital records; willfully and knowingly making false statements for creating, amending or applying for birth and death records and/or obtaining, possessing or using a vital record for purposes of deception; mutilating or destroying an original vital record.  Up to $10,000 and 90 days imprisonment for willfully and knowingly making false statements for creating, amending or applying for marriage records.